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Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study.

ABSTRACT: Introduction:D2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). Number of lymph nodes (LN) harvested is an important factor for accurate staging. The number of LN retrieved and the metastasis LN status are also important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection. Patients and methods:Single center retrospective cohort study of GC patients underwent curative resection from January 1995 to December 2016 was conducted. The patients were categorized into 3 groups based on LNR (0.00-0.35, >0.35-0.75, and >0.75-1.00) and 2 groups based on number of LN retrieved (<15 and ? 15). Kaplan-Meier method was used to estimate recurrence-free survival. Cox-regression were used to determine the association between LNR/other factors and the disease recurrence. Results:One-hundred fifty-three patients were included in analysis. Univariate analysis showed that LNR >0.35, pathologic LN stages (pN) 2-3, higher number of LN metastasis, and TNM stage III were significantly recurrence risk factors. After adjusting for several covariates, LNR >0.35 still was significant predictor (adjusted HR [95%CI], 8.53 [1.97, 36.86]; p = 0.004) while number of LN retrieved or number of metastasis LN were not. Conclusion:LNR could be a strong indicator for the recurrence of GC after curative resection while the number of LN retrieved or metastasis did not predict the recurrence. Future studies, such as prospective studies, are needed to confirm and identify the optimum LNR cut-off.

SUBMITTER: Supsamutchai C

PROVIDER: S-EPMC7191314 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study.

Supsamutchai Chairat C Wilasrusmee Chumpon C Jirasiritham Jakrapan J Rakchob Teerawut T Phosuwan Songpol S Chatmongkonwat Tanet T Choikrua Pattawia P Thampongsa Tharin T

Annals of medicine and surgery (2012) 20200419

<h4>Introduction</h4>D2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). Number of lymph nodes (LN) harvested is an important factor for accurate staging. The number of LN retrieved and the metastasis LN status are also important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection.<h4>Patients and methods</h4>Single center retrospe ...[more]

PMID: 32373343

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Project description:Increasing lymph node ratio (LNR) (ratio of metastatic lymph nodes to the total number of harvested lymph nodes) and extramural vascular invasion (EMVI) have been proposed as adverse prognostic indicators in colorectal cancer, although their use remains variable and controversial. The aim of the present study was to assess the prognostic value of LNR and EMVI in predicting survival for patients undergoing curative colon cancer resection.Between 2006 and 2012, 922 patients underwent curative colon cancer resection. Surgical technique and pathological assessment did not change during the study period. Clinical and pathological data were collected from a prospectively maintained database. The primary outcome measure was overall survival and disease-free survival. LNR was separated into five categories based on three previously calculated cutoff values: LNR 0 (no lymph nodes involved), LNR 1 (ratio 0.01<0.17), LNR 2 (ratio 0.18-0.41), LNR 3 (ratio 0.42-0.69), and LNR 4 (ratio >0.70).Nine hundred and twenty-two patients underwent colon cancer resection. The median follow-up for survivors was 52.8 months (IQR 34.6-77.6). The median total number of lymph nodes harvested was 16 (IQR13-22). On multivariate analysis, both pN and LNR were strongly associated with overall and disease-free survival. Using the Akaike information criterion (AIC), LNR had greater prognostic value compared with pN. For overall survival, compared with patients in LNR category 0, hazard ratios (95% CI) for those in categories 1, 2, 3 and 4 were 1.37 (1.03,1.82), 2.37 (1.70,3.30), 2.40 (1.57,3.65) and 5.51 (3.16,9.58), respectively. For disease-free survival, patients had hazard ratios (95% CI) of 1.78 (1.25,2.52), 3.79 (2.56,5.61), 2.60 (1.50,4.48) and 4.76 (2.21,10.27), respectively. The presence of EMVI was a significant predictor of decreased overall and disease-free survival (P<0.001).This study demonstrated, in the presence of high surgical, oncology and pathological standards, EMVI and increasing LNR were independent predictors of decreased overall and disease-free survival for patients undergoing curative colon cancer resection. LNR was superior to pN stage in predicting overall and disease-free survival.

Project description:BACKGROUND:High-quality randomized controlled trials have demonstrated the benefit of radiotherapy (RT) in patients with radical resected gastric cancer (GC), however, utilization rates of postoperative RT remain remarkably low. Patterns, incidences, and time of recurrence provide biological bases for clinical monitoring of GC patients and guiding potential complementary therapies. Thus, the aim of this study is to understand the location of locoregional recurrence which may allow individualized RT strategies and minimize radiation-related toxic effects. METHODS:A relatively large sample of GC patients in a single institution who had undergone curative D2 resection was retrospectively reviewed and the relevant recurrence patterns were illustrated. Independent recurrence-related risk factors were analyzed by logistic regression analysis. New logistic regression models were further developed to predict the probability of recurrence. RESULTS:Overall, among 776 GC patients who had continuous and complete follow-up data, 300 cases relapsed after curative resection. Lymphovascular invasion, lymph node metastases, and tumor stage were indicators for early recurrence. Peritoneal, regional, local, and distant recurrence initially occurred in 51 (6.6%), 151 (19.4%), 56 (7.2%), and 164 (21.1%) patients, respectively. Among patients with regional recurrence, the most common sites were lymph node stations 16a2, 8, 12, 16b1, and 9. Remnant stomach recurrence was not so prominent that it seemed reasonable to be excluded from an irradiation field for patients with negative surgical/pathologic margins. CONCLUSIONS:For GC patients who underwent radical D2 resection, distant and regional recurrences were still common. Besides, optimizing regional control of lymph nodes outside the D2 dissected area was crucial for rational design of the RT field. Furthermore, the new logistic regression models might act as useful tools to evaluate recurrence risk and determine which patients should receive postoperative chemoradiotherapy.

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Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study.

Publications

Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study.

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